Optimizing access to cancer screening is an important goal for all healthcare organizations, including the ACR. Still, many issues persist. In rural areas, for example, patients have limited access to screening. In some instances, portable equipment could help ensure that patients in underserved communities receive potentially lifesaving screenings.
In 2017, the first mobile lung cancer screening (LCS) vans appeared in North Carolina. Since that time, mobile CT has been spreading across the country, in both rural and urban areas. Mobile units can provide convenient patient access to screening CTs at federally qualified health centers, community centers, local or county health departments, parking lots, or wherever there is space. These units can perform low-dose lung CT (LDCT) scans in minutes. In fact, the National Lung Screening study showed that LDCT scans provided by mobile units can find cancer early and help reduce lung cancer deaths by roughly 20%. In addition, some mobile screening units offer health counseling, smoking cessation support and follow-up care.
It is important for all radiologists to help get the word out to patients who are at increased risk of developing lung cancer and can benefit from these services — including how to connect with mobile lung screening units in their communities. The Bulletin spoke to Martha Menchaca, MD, PhD, chair of the Lung Cancer Screening Patient and Community Engagement Subcommittee, about mobile screening efforts and how ACR members can help educate the public on these services.
How did mobile lung cancer screening programs get started?
In February of 2015, the Centers for Medicare and Medicaid Services (CMS) began to cover LCS — and this allowed for reimbursement for LDCT screening. Being able to ensure payment for LDCT led to discussions of ways hospitals could bring their services to patients in rural areas instead of patients driving long distances to access screening services at hospitals. In 2017, Atrium Health Levine Cancer in Charlotte, NC, with the help of grant funding from The Bristol Myers Squib Foundation, created the first Mobile Lung Screening Program. Additionally, in February of 2022, CMS expanded their National Coverage Determination of lung cancer screening with low-dose CT, lowering the screening start age from 55 to 50 years old.
Why are these programs needed and worth expanding nationwide?
They are especially important for screening and diagnosing lung cancer in rural and underserved communities — and ultimately improving access to care and reducing disparities in screening and treatment outcomes. There are currently 14.5 million people who are eligible for these programs based on the USPSTF recommendations. However, everyone who is eligible does not have easy access to screening. Many state affiliated hospitals and medical centers are now starting mobile LDCT programs that make access easier and more affordable for high-risk individuals in remote areas. These programs are not limited to rural areas — you can find them in largely populated cities, such as New York City and Los Angeles. Even in urban areas where it can be very hard to navigate scheduling, patients have a potentially easier mobile option.
These programs increase access by bringing mobile LDCT scans directly into local communities to reduce screening disparities and reach high-risk individuals to get access to the care they need.
What type of impact do these programs have on communities where access to screening is limited?
These programs increase access by bringing mobile LDCT scans directly into local communities to reduce screening disparities and reach high-risk individuals to get access to the care they need. These units help them schedule their appointments and then provide them with follow-up care if needed. The return times on scan results are also similar to that of a hospital, so it’s time-efficient for patients.
What have some of the challenges been in developing these programs?
The number one issue is funding. Before CMS expanded their National Coverage Determination of lung cancer screening with LDCT, reimbursement for LDCT was not possible. Once reimbursement became available, people started acting on it. It's a large financial investment for the healthcare system. You also need people to manage these units, there are equipment space limitations, and you need scheduling — ideally occurring at least three weeks before the screening. It’s important to have a good network of primary care providers who can refer and ensure at-risk people are signing up for appointments. It is equally important that there is shared decision-making, which is a required counseling visit between a patient and a doctor before ordering an initial LDCT. This will ensure that the largest number of eligible patients can benefit and the program will be financially self sufficient.
Marketing and advertising are also a challenge. Methods can range from units communicating directly with county health departments, local hospitals and physicians or putting ads in local newspapers. There are advertisements at bus stops and on billboards. Additionally, there many programs advertise in different languages to make information accessible to non-English speakers. New campaigns may also include social media outreach to spread the word to members of a secluded and difficult to reach community.
How can patients find a mobile lung screening unit that is close to them?
There is no singular, nationwide public directory that lists every active mobile LDCT unit. However, the ACR Lung Cancer Screening Locator is one way to find a nearby unit in your area. Additionally, the American Lung Association provides a helpline, 844-ALA-Lung, for one-on-one help with locating units using your zip code.
How can ACR members get involved with mobile screening efforts to reduce disparities in lung cancer screening?
The best way is to make sure that our ACR members know where these units are in their states and then make that information available to primary care physicians who can counsel patients most at risk. ACR members can become active in their state ACR chapters and become familiar with programs in their states. Getting the word out about these programs is the best way we can help eligible at-risk patients. Hopefully, more programs like this will emerge to help even more patients across the country.
By Alex Utano, associate editor, ACR Bulletin
